Tiemuerniyazi Xieraili, Xu Fei, Song Yangwu, Nan Yifeng, Yang Ziang, Chen Liangcai, Zhao Dong, Zhao Wei, Feng Wei
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 10037 Beijing, China.
Department of Cardiovascular Surgery, Yunnan Fuwai Cardiovascular Hospital, 650000 Kunming, Yunnan, China.
Rev Cardiovasc Med. 2023 Jan 3;24(1):5. doi: 10.31083/j.rcm2401005. eCollection 2023 Jan.
Treatment of moderate functional mitral regurgitation (FMR) during aortic valve replacement (AVR) is controversial. This study aimed to evaluate the effect of different surgical strategies in patients with moderate FMR undergoing AVR.
A total of 468 patients with moderate FMR undergoing AVR from January 2010 to December 2019 were retrospectively studied comparing 3 different surgical strategies, namely isolated AVR, AVR + mitral valve repair (MVr) and AVR + mitral valve replacement (MVR). Survival was estimated using the Kaplan-Meier method and compared with the log-rank test, followed by inverse probability treatment weighting (IPTW) analysis to adjust the between-group imbalances. The primary outcome was overall mortality.
Patients underwent isolated AVR (35.3%), AVR + MVr (30.3%), or AVR + MVR (34.4%). The median follow-up was 27.1 months. AVR + MVR was associated with better improvement of FMR during the early and follow-up period compared to isolated AVR and AVR + MVr ( 0.001). Compared to isolated AVR, AVR + MVR increased the risk of mid-term mortality (hazard ratio [HR]: 2.13, 95% confidence interval [CI]: 1.01-4.48, = 0.046), which was sustained in the IPTW analysis (HR: 4.15, 95% CI: 1.69-10.15, = 0.002). In contrast, AVR + MVr showed only a tendency to increase the risk of follow-up mortality (HR: 1.63, 95% CI: 0.72-3.67, = 0.239), which was more apparent in the IPTW analysis (HR: 2.54, 95% CI: 0.98-6.56, = 0.054).
In patients with severe aortic valve disease and moderate FMR, isolated AVR might be more reasonable than AVR + MVr or AVR + MVR.
主动脉瓣置换术（AVR）期间中度功能性二尖瓣反流（FMR）的治疗存在争议。本研究旨在评估不同手术策略对接受AVR的中度FMR患者的影响。
回顾性研究了2010年1月至2019年12月期间共468例接受AVR的中度FMR患者，比较了3种不同的手术策略，即单纯AVR、AVR+二尖瓣修复（MVr）和AVR+二尖瓣置换（MVR）。采用Kaplan-Meier法估计生存率，并与对数秩检验进行比较，随后进行逆概率治疗加权（IPTW）分析以调整组间不平衡。主要结局为全因死亡率。
患者接受单纯AVR（35.3%）、AVR+MVr（30.3%）或AVR+MVR（34.4%）。中位随访时间为27.1个月。与单纯AVR和AVR+MVr相比，AVR+MVR在早期和随访期间FMR的改善更好（P<0.001）。与单纯AVR相比，AVR+MVR增加了中期死亡风险（风险比[HR]：2.13，95%置信区间[CI]：1.01-4.48，P=0.046），IPTW分析中该风险持续存在（HR：4.15，95%CI：1.69-10.15，P=0.002）。相比之下，AVR+MVr仅显示出随访死亡风险增加的趋势（HR：,1.63，95%CI：0.72-3.67，P=0.239），在IPTW分析中更明显（HR：2.54，95%CI：0.98-6.56，P=0.054）。
在重度主动脉瓣疾病和中度FMR患者中，单纯AVR可能比AVR+MVr或AVR+MVR更合理。
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